Hydroxychloroquinine updates (and other potential treatments)

[GooooMarquette]

I honestly try to do this when feasible.

Do you know how difficult it is to find a "made in USA" garden hose on Amazon?

Same here. I have transitioned most of what I wear to Made in USA stuff, but it has taken time and effort. Like you said, you don't find a lot on Amazon or local places. Most has to be ordered straight from the manufacturer.

[reinko]

Would it surprise you if in the relatively near future consumers were willing to reward companies manufacturing important drugs in the USA rather than China even if it cost them a little more?

So it's on the consumer to pay more, not the company to make less.

Perhaps we can find a middle road?

[Lennys Tap]

So it's on the consumer to pay more, not the company to make less.

Perhaps we can find a middle road?

Perhaps. Some give on both sides would be best for all.

[tower912]

That is usually the case in most things.

[Bo Ryan's Massage Therapist]

Here is info if you want to follow a clinical trial on hydroxychloroquine

https://www.nih.gov/news-events/news-releases/nih-clinical-trial-hydroxychloroquine-potential-therapy-covid-19-begins

[TSmith34, Inc.]

Over 100 drugs and compounds now being tested.

The Best Hopes for a Coronavirus Drug
https://www.theatlantic.com/science/archive/2020/04/what-coronavirus-drug-will-look-like/609661/

[Elonsmusk]

https://www.newsweek.com/hydroxychloroquine-coronavirus-france-heart-cardiac-1496810

Risk factor go up exponentially if adding azithromycin to hydroxy, as that extends QT, escalating risk.

"Ferrari said that hydroxychloroquine on its own presents only a small cardiac risk. However, when given alongside the antibiotic azithromycin, with which it is being prescribed in combination for the treatment of coronavirus, the risk increases."

[forgetful]

Risk factor go up exponentially if adding azithromycin to hydroxy, as that extends QT, escalating risk.

"Ferrari said that hydroxychloroquine on its own presents only a small cardiac risk. However, when given alongside the antibiotic azithromycin, with which it is being prescribed in combination for the treatment of coronavirus, the risk increases."

Yes, this has been discussed on here. And it is important to note, that no studies have shown hydroxy to be effective on its own. The only studies (no controls) that showed efficacy were with azithromycin.

[Elonsmusk]

Uhhh, isn't this just your normal free market capitalism?

Company A produces widget B in the USA for y amount of dollars.  Finds out can produce widget B can be produced for Z amount of dollars in India or China.

Y>Z , thus company moves manufacturing to India or China.

Okay.  Do you consider the imposition of minimum wage and mandatory company paid benefits, etc., to be free market?

I find it confounding that most employer/employee contracts are set up "at-will."  The employee takes no risk in going to work for the employer - if they don't like the work conditions, management, compensation - nothing stopping them from walking out the door and finding a better fit for themselves.

People get angered over the loss of middle class jobs, and that the middle class are being left behind.  Well, we've essentially given our domestic companies little choice but to outsource given the mandated wage/benefit protections here, as compared to China/India.

[TSmith34, Inc.]

People get angered over the loss of middle class jobs, and that the middle class are being left behind.  Well, we've essentially given our domestic companies little choice but to outsource given the mandated wage/benefit protections here, as compared to China/India.

IMO, we shouldn't aspire to be China or India when it comes to wages and benefits. Germany would be a much better comparator.

[Coleman]

Back on topic, does anyone know when we will hear an update on remdesivir trials? I think this one holds the most promise...way more than hydroxchlorquinine

[Coleman]

Ha, just googled and answered my own question. It is good news, but not conclusive (no control):

https://www.nejm.org/doi/full/10.1056/NEJMoa2007016

https://www.businessinsider.com/gilead-remdesivir-clinical-data-in-covid-19-patients-2020-4


"Of the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post-treatment data and 1 with a dosing error). Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57%) were receiving mechanical ventilation and 4 (8%) were receiving extracorporeal membrane oxygenation. During a median follow-up of 18 days, 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and 7 patients (13%) died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation."



Not a miracle drug, but a 18% mortality rate of patients on ventilation is probably an improvement over a placebo.

[pbiflyer]

Given that we see survival rates of 20-25% on ventilation, that would be an impressive improvement.

[JWags85]

IMO, we shouldn't aspire to be China or India when it comes to wages and benefits. Germany would be a much better comparator.

I think he was meaning moreso we can't compete with China/India cause we have wages and benefits that treat workers like people, and not utterly disposable labor.  People can complain about worker treatment or wages in the US (with some merit), but its nothing compared to those countries which is why they can produce at a fraction of the cost.

[tower912]

Detroit is trying it as a prophylactic.   Skeptical, but support every experiment.

[Frenns Liquor Depot]

Good news

https://www.washingtonpost.com/business/2020/04/10/gileads-experimental-drug-remdesivir-shows-hopeful-signs-small-group-coronavirus-patients

[Coleman]

Given that we see survival rates of 20-25% on ventilation, that would be an impressive improvement.

Agreed. The real impact will be if we see significant improvements in patients before they are put on ventilators.

I think this is far and away our best shot. At least until vaccine. Convalescent antibodies are another weapon, but tougher to scale.

[Coleman]

Detroit is trying it as a prophylactic.   Skeptical, but support every experiment.

What do you mean? They are giving remdesivir to healthy people? That seems kind of an insane waste of resources

[tower912]

What do you mean? They are giving remdesivir to healthy people? That seems kind of an insane waste of resources

Hydroxychloroqinine

[Coleman]

Hydroxychloroqinine

Also seems foolish considering there are lupus patients unable to get their needed medicine

[tower912]

Testing it to see if it can ultimately used as a vaccine. 

[GooooMarquette]

Testing it to see if it can ultimately used as a vaccine.

Used "as a vaccine" or as an adjunct to vaccines that are being developed? Because it definitely is not the former...

[tower912]

They are testing 3000 healthy doctors, nurses, first responders.   Placebos, different dosing, daily v weekly, etc. 

[Hards Alumni]

https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v1

    Background: Hydroxychloroquine has recently received Emergency Use Authorization by the FDA and is currently prescribed in combination with azithromycin for COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with azithromycin.

    Methods: New user cohort studies were conducted including 16 severe adverse events (SAEs). Rheumatoid arthritis patients aged 18+ and initiating hydroxychloroquine were compared to those initiating sulfasalazine and followed up over 30 days. Self-controlled case series (SCCS) were conducted to further establish safety in wider populations. Separately, SAEs associated with hydroxychloroquine-azithromycin (compared to hydroxychloroquine-amoxicillin) were studied. Data comprised 14 sources of claims data or electronic medical records from Germany, Japan, Netherlands, Spain, UK, and USA. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate calibrated hazard ratios (CalHRs) according to drug use. Estimates were pooled where I2<40%.

    Results: Overall, 956,374 and 310,350 users of hydroxychloroquine and sulfasalazine, and 323,122 and 351,956 users of hydroxychloroquine-azithromycin and hydroxychloroquine-amoxicillin were included. No excess risk of SAEs was identified when 30-day hydroxychloroquine and sulfasalazine use were compared. SCCS confirmed these findings. However, when azithromycin was added to hydroxychloroquine, we observed an increased risk of 30-day cardiovascular mortality (CalHR2.19 [1.22-3.94]), chest pain/angina (CalHR 1.15 [95% CI 1.05-1.26]), and heart failure (CalHR 1.22 [95% CI 1.02-1.45])

    Conclusions: Short-term hydroxychloroquine treatment is safe, but addition of azithromycin may induce heart failure and cardiovascular mortality, potentially due to synergistic effects on QT length. We call for caution if such combination is to be used in the management of Covid-19.

[forgetful]

https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v1

Given that heart failure is one of the possible outcomes of COVID-19. There have likely been people on this treatment that died of heart failure, and we will never know whether it was from the treatment or the disease, or both.